1. Name (child)
2. Age _______________ Date of birth ______________
3. Request from parents ___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
4. Manifestations recorded by a psychologist _____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
5. Choice of toys and objects of manipulation ___________________________________
_____________________________________________________________________________
_____________________________________________________________________________
6. The form of the child’s play activity:
– storytelling,
– role-playing games,
– simple manipulations,
– consideration,
– another variant _______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
7. Motivation for gaming activity:
– initiates himself, constantly plays,
Need a psychologist support
– loses interest quickly
\u2013 it is impossible to stop the activity.
8. Activity levels:
– passive,
– selectively active
\u2013 active during all game manipulations.
9. Contact and need for reinforcements:
– constantly seeks support from parents,
– constantly seeks support from a psychologist,
– does not need support in the process of gaming activity.
10. Time and duration of game manipulations:
– playing time with one object up to 1 min.,
– playing time with one object up to 3 minutes,
– playing time with one object up to 7 minutes,
game time with one object up to 15 minutes.
11. Subject of comments during the child’s play activity: _______________________
_____________________________________________________________________________
_____________________________________________________________________________
12. Topics of comments on the child’s play activities, parents (if present) at the lesson: __________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
13. The main game theme of the child: _______________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
14. The emotional state of the child during play activities:
– stable positive state,
– stable negative state,
– changeable emotional state
– abrupt mood swings
– other variations _________________________________________________________________
15. Persons who were actually or virtually involved in the child’s play: __________________
_____________________________________________________________________________
16. Explanation of the child regarding incomprehensible, fantasy plots and elements of the game:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
17. Behavioral features during gaming activities: ___________________________
_____________________________________________________________________________
_____________________________________________________________________________<\/p>\n
Psychologist’s conclusions: __________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________<\/p>\n
Recommendations for parents: ________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________<\/p>\n
Prospects for further corrective work: ___________________________________
_____________________________________________________________________________
_____________________________________________________________________________<\/p>\n
Date __________________ Signature _________________<\/p>\n
\u00a9 V.V. Nazarevich<\/p>\n","protected":false},"excerpt":{"rendered":"
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